International term life insurance policy General Conditions:

International term life insurance policy:

Term life insurance is a type of life insurance that policyholder guarantees payment of a stated death benefit to beneficiaries if the covered person dies during a specified term. There will be no premium payment if the insured outlive the life insurance term.

Insurer:

The insurer will be saman insurance company that provides the insurance cover.

Insured: 

The insured is the person whose death is covered by the policy and is the subject matter of the policy and his\her age & health condition is the basis of premium calculation. 

Policyholder:

A person or entity who owns the policy and the life insurance contract is between an insurer and the policyholder and policyholder Commits to pay premiums and installments of the policy. 

Beneficiary:

Is the person or entity entitled to receive the claim amount and other benefits upon the contract. From the death date of the insured, all the benefits will belongs to the legal heirs of the insured unless another person has already been mentioned as a beneficiary in the policy. 

Subject matter of insurance: 

The subject matter of term life insurance is death of the insured based on principles of term Life Insurance contract. 

Validation of contract and annexes:

The policy is completed at the policyholder’s written offer and is issued based on the questionnaire filled by him/her and the physician report. 

If the physician obliged to assess the insured’s mental and physical records, which is not possible to determine by a medical examination, the insured's statements are not true or and the insured refused to express important information for policy that has been effective in concluding the policy will be measured as follows : 

If the insurer finds out about the insured’s unrealistic statements before the occurrence of the risk, the insurer is permitted to cancel the policy of the insured or continue the policy by receiving an additional rate. 

If the insurer finds out about the insured's unrealistic statements after the occurrence of the risk the insurer's commitment will be reduced in proportion to the difference in the insurance rate if the truth is stated and if the discovery of truth is so serious that would have pretended the insurer from signing the policy contract on the premium will be refund after the subtraction of 10 to 20 % of administrative expenses and the policy will be canceled from the date of issue. 

The commitment of insurer, policyholder and the insured and any benefits of the policy are specified and riders based on insured’s request and consent of the insurer will occur any changes of the contract. In addition, these bonds are an integral part of the insurance contract.

This policy is binding on both sides according to the following items except in case of proving misrepresentation, and it will not be challenged in any way.

The policy validation coverages mentioned in the policy will officially commence from the issue date and the first payment, providing that the health condition of the insured has not changed since filling the proposal.

The policyholder is obliged to pay premium according to the policy and its annexes and the policy validation depends on the premium payment at the issue date. In case that premium is not paid the insurer may terminate the policy.

Clause 3- Other risks

The following risks and incidents are covered if they do not have conflict with private conditions. 

The insurer accepts the insured death due to the risks of air travel (passenger aircraft) without receiving extra premium and prior notice from the policyholder, provided that the insured travels as a regular passenger on commercial and authorized transport lines.

Clause 4- Exceptions  

1. Suicide: when the insured commits suicide in the first two years of the policy, meaning that the insured’s death has been done by him-/herself for any reason, the death benefit will not be paid. 
2. Risks from speed racing, exploration, acrobatic flights and any training related to the mentioned risks are not covered by this policy.
3. War, riot, uprising, strike, chaos.
4. All losses related to earthquake, flood, volcano (in case of agreement between the insurer and the policyholder, provided that extra premium is paid, these risks will be covered)
5. All losses related to nuclear radiation, nuclear explosion and radioactive in case of agreement between the insurer and the policyholder, provided that extra premium is paid, these risks will be covered)

 Clause 5- Beneficiaries rights: 

The policyholder has the right to inform the insurer in writing stating the name and surname and identity number of each of them during policy term.

2- The legal effects of using life insurance start from the insured's date of death, otherwise if the policyholder has received money from the insurer for any reason, the insurer's commitment will be reduced in proportion to that amount.

3- The death benefit belongs to the legal heir of the insured from the insured's date of death, unless another person has already been mentioned as a beneficiary in the policy and the beneficiary designation form, in which case the death benefit will belong to the persons their names are mentioned in these documents. 

Provision: If the role of beneficiaries in the insured’s death is proved, their share of the death benefit will not be paid. If the role of one of beneficiaries in the insured’s death is proved, his/her share will be deducted from benefit and other beneficiaries’ share will be paid. 

Clause 6- Legal address - changing the residence of the representative in Iran: 

2. The policyholder is obliged to inform the insurer in writing the change of residence.

3- The policyholder can follow up all its requests in writing from one of the company's branches.

Clause 7- prescriptive period

 The prescriptive period for all legal claims arising from this contract is two years

Clause 8- Legal claims

Every debatable topic in this policy will be refereed and reconciled. In this case, each side choses a referee, then the referees specify a head-referee. The vote of the majority is binding for both sides. The related expenses for each referee will be paid by the pertaining side and the head-referee expenses will be divided between the sides.

The general conditions of this policy and its ensuing effects are valid only if sealed and signed by Saman Insurance.

Conditions of Accidental Medical Expenses coverage

Clause 1- Insurance Topic: 

Based on this annex, by receiving the extra premium, the insurer guarantees to cover accidental medical expenses up to this annex’s sum insured.

Clause 2- Risks Coverage

Any sudden event that is caused by an external factor, totally unintended by the insured is covered in this annex.

Clause 3- The commitments of the policyholder and the he insured:

1. The policyholder is required to pay the annual premium according to the bot side agreement. 
2. The insured’s job switching must be informed to the insurer by the policyholder; otherwise less indemnity will be paid in proportion to the insured’s risk augmentation.
3. The policyholder or the insured is obliged to inform the insurer in writing at most 30 days after occurrence of the accident.
4.  Providing the original hospital bills to receive compensation

Clause 4- Insurer’s Commitments:

 The insurer guarantees that medical expenses according to the original bills up to accidental medical expenses sum insured, which is not paid by other insurers, will be paid to the insured.

Medical expenses is equal to the minimum between medical expenses sum insured and bill amounts, provided that documents will be submitted to the insurer within 60 days after bill payment. 

1. The maximum insurer’s commitment for each accident is 20% of death benefit up to 200.000.000 IRR.  
2. All of accident within 7 days are consider as an accident. 

Clause 5- Coverage period:

The coverage period is a complete solar year, beginning from the 00:00’ o’clock of the day specified in the policy to that exact time next year, unless otherwise are agreed upon between the two sides.

Provision: the maximum age of the insured for using this coverage is 60 years.

Clause 6- Exceptions:

In addition to the exceptions and limitations cited in the life insurance general conditions, the following items are excluded from the insurer’s commitment:

1. Intentional Body damages caused by the insured.
2. Any kind of intervertebral disc or arthritis.
3. Any event that was planned by the beneficiary (including management, participation, or assistance).  
4. Any event resulted in drunkenness or any use of drug and stimulants without doctor’s permission.
5. Committing crimes, including management, participation or any assistance.
6. Any event for the insured when driving a vehicle without having its certificate.
7. Any event that occurred before policy issue date.

Clause 7- Other risks:

The following risks are not included in the insurer’s commitment, unless by paying extra premium and the insurer’s agreement.

a) Earthquake and volcano.

b) Martial arts, hunting, riding (horse and etc.), boating, steering gear motorcycles, riding or sitting in vehicles (aerial, rail, marine) in races or exploratory flights or any other training, swimming training, air flight, parachuting (free fall), kiting or riding other motor-less vehicles

This rider and its ensuing effects are applicable and valid only if officially signed and confirmed by Saman Insurance.

Conditions of premium critical illness coverage

Clause 1. Insurer’s commitment 

Pursuant to this coverage, the insurer in exchange for receiving additional premium is obliged to pay the critical illness sum assured, in case the insured becomes sick by any disease mentioned in clause 2.

Clause 2. Diseases covered

Diseases covered by this rider include four categories separately for children and adults. 

G1 – Cancer: Cancer, Bone Marrow Transplantation

G2 – Cardio: Stroke, First Heart Attack (Myocardial Infarction), Aorta Surgery, Coronary Artery Bypass Graft Surgery, Heart Valve Surgery, Transplantation Heart / Kidney, Kidney Failure (Renal failure)

G3 – Neuro: Benign Brain Tumor, Persistent Vegetative State(Apallic syndrome), Muscular Dystrophy, Idiopathic Parkinson’s Disease, Alzheimer’s Disease, Motor Neuron Disease, Amyotrophic Lateral Sclerosis, Coma, Major Head Trauma, Profound Vision Loss, Loss of Speech, Loss of Hearing, Paralysis of Limbs, Acute Viral Encephalitis, Multiple Sclerosis

G4 – Other: End-stage Liver Failure, End-stage lung disease (Chronic Lung Disease), Major Burns, Fulminant Viral Hepatitis, Chronic Pancreatitis, Transplantation (Liver, Lung, Small Bowel, Pancreas, Composite Tissue), Severe Rheumatoid Arthritis 

G1 – Cancer: Cancer, Bone Marrow Transplantation

G2 – Cardio: Transplantation Heart / Kidney

G3 – Neuro: Benign Brain Tumor, Persistent Vegetative State (Apallic syndrome), Coma, Major Head Trauma, Profound Vision Loss, Loss of Speech, Loss of Hearing, Paralysis of Limbs, Multiple Sclerosis

G4 – Other: End-stage Liver Failure, End-stage lung disease (Chronic Lung Disease), Major Burns, Fulminant Viral Hepatitis, Chronic Pancreatitis, Transplantation (Liver, Lung, Small Bowel, Pancreas, Composite Tissue), Severe Rheumatoid Arthritis.

Clause 3.    Disease definition: 

Critical Illness Definitions – Adult Covers

Any malignant tumor positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The diagnosis must be confirmed by a Specialist.  

Unless not specifically excluded, leukemia, malignant lymphoma and myelodysplastic syndrome are covered under this definition. 

For the above definition, the following are not covered:

- Any tumor histologically classified as pre-malignant, non-invasive or carcinoma in situ (including ductal and lobular carcinoma in situ of the breast and cervical dysplasia CIN-1, CIN-2 and CIN-3)

- Any prostate cancer unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0.

- Chronic lymphocytic leukemia unless having progressed to at least Binet Stage B

- Basal cell carcinoma and squamous cell carcinoma of the skin and malignant melanoma stage IA (T1aN0M0) unless there is evidence for metastases

- Papillary thyroid cancer less than 1 cm in diameter and histologically described as T1N0M0

- Papillary micro-carcinoma of the bladder histologically described as Ta

- Polycythemia rubra vera and essential thrombocythemia

- Monoclonal gammopathy of undetermined significance

- Gastric MALT Lymphoma if the condition can be treated with Helicobacter- eradication 

- Gastrointestinal stromal tumor (GIST) stage I and II according to the AJCC Cancer Staging Manual, Seventh Edition (2010)

- Cutaneous lymphoma unless the condition requires treatment with chemotherapy or radiation 

- Microinvasive carcinoma of the breast (histologically classified as T1mic) unless the condition requires mastectomy, chemotherapy or radiation

- Microinvasive carcinoma of the cervix uteri (histologically classified as stage IA1) unless the condition requires hysterectomy, chemotherapy or radiation. “

- Bone marrow (allogeneic hematopoietic stem cell transplantation preceded by total bone marrow ablation)

For the above definition, the following are not covered:

- Transplantation of other organs, body parts or tissues (including cornea and skin)

- Transplantation of other cells (including islet cells and stem cells other than hematopoietic)"

- Symptoms of ischemia (like chest pain)

- Electrocardiogram (ECG) changes indicative of new ischemia (new ST-T changes or new left bundle brunch block)

- Development of pathological Q waves in the ECG

The diagnosis must be confirmed by a Consultant Cardiologist. 

For the above definition, the following are not covered:

- Acute coronary syndrome (stable or unstable angina) 

- Elevations of troponin in the absence of overt ischemic heart diseases (e.g. myocarditis, apical ballooning, cardiac contusion, pulmonary embolism, drug toxicity) 

- Myocardial infarction with normal coronary arteries or caused by coronary vasospasm, myocardial bridging or drug abuse

- Myocardial infarction that occurs within 14 days after coronary angioplasty or bypass surgery"

Death of brain tissue due to an acute cerebrovascular event caused by intracranial thrombosis or hemorrhage (including subarachnoid hemorrhage), or embolism from an extracranial source with

- Acute onset of new neurological symptoms, and

- New objective neurological deficits¹ on clinical examination. 

The neurological deficit must persist for more than 3 months following the date of diagnosis. The diagnosis must be confirmed by a Consultant Neurologist and supported by imaging findings. 

For the above definition, the following are not covered:

- Transient Ischemic Attack (TIA) and Prolonged Reversible Ischemic Neurological Deficit (PRIND); 

- Traumatic injury to brain tissue or blood vessels

- Neurological deficits due to general hypoxia, infection, inflammatory disease, migraine or medical intervention

- Incidental imaging findings (CT- or MRI-scan) without clearly related clinical symptoms (silent stroke)

- Death of tissue of the optic nerve or retina or vestibular organ"

The undergoing of heart surgery to correct narrowing or blockage of two or more coronary arteries with bypass grafts. Heart surgery with full sternotomy (vertical division of the breastbone) and minimally invasive procedures (partial sternotomy or thoracotomy) are covered.  The surgery must be determined to be medically necessary by a Consultant Cardiologist or Cardiac Surgeon and supported by coronary angiogram findings.

For the above definition, the following are not covered:

- Bypass surgery to treat narrowing or blockage of one coronary artery

- Coronary angioplasty or stent-placement"

Chronic and irreversible failure of both kidneys, as a result of which either regular hemodialysis or peritoneal dialysis is instituted or renal transplantation is carried out. The dialysis must be medically necessary and confirmed by a Consultant Nephrologist.

For the above definition, the following are not covered:

- Acute reversible kidney failure with temporary renal dialysis"

- Heart

- Kidney

- Liver (including split liver and living donor liver transplantation)

- Lung (including living donor lobe transplantation or single-lung transplantation)

- Bone marrow (allogeneic hematopoietic stem cell transplantation preceded by total bone marrow ablation)

- Small bowel

- Pancreas 

Partial or full face, hand, arm and leg transplantation (composite tissue allograft transplantation) is covered under this definition, too. The condition leading to transplantation must be deemed untreatable by any other means, as confirmed by a Specialist. 

For the above definition, the following are not covered:

- Transplantation of other organs, body parts or tissues (including cornea and skin)

- Transplantation of other cells (including islet cells and stem cells other than hematopoietic) "

Total and irreversible loss of muscle function to the whole of any 2 limbs as a result of injury to, or disease of the spinal cord or brain. Limb is defined as the complete arm or the complete leg. Paralysis must be present for more than 3 months, confirmed by a Consultant Neurologist and supported by clinical and diagnostic findings. 

For the above definition, the following are not covered:

- Paralysis due to self-harm or psychological disorders

- Guillain-Barré-Syndrome

- Periodic or hereditary paralysis"

Profound vision loss of both eyes resulting from either disease or trauma that cannot be corrected by refractive correction, medication, or surgery. Profound vision loss is evidenced by either a visual acuity of 3/60 or less (0.05 or less in the decimal notation) in the better eye after best correction or a visual field of less than 10° diameter in the better eye after best correction. The diagnosis must be confirmed by a Consultant Ophthalmologist."

The undergoing of surgery to replace or repair one or more defective heart valves. The following procedures are covered under this definition:

- Heart valve replacement or repair with full sternotomy (vertical division of the breastbone), partial sternotomy or thoracotomy

- Ross-Procedure

- Catheter-based valvuloplasty

- Transcatheter aortic valve implantation (TAVI) 

The surgery must be determined to be medically necessary by a Consultant Cardiologist or Cardiac Surgeon and supported by echocardiogram or cardiac catheterization findings.

For the above definition, the following are not covered:

- Transcatheter mitral valve clipping"

The undergoing of surgery to treat narrowing, obstruction, aneurysm or dissection of the aorta. Minimally invasive procedures like endovascular repair are covered under this definition. The surgery must be determined to be medically necessary by a Consultant Surgeon and supported by imaging findings.

For the above definition, the following are not covered:

- Surgery to any branches of the thoracic or abdominal aorta (including aortofemoral or aortoiliac bypass grafts)

- Surgery of the aorta related to hereditary connective tissue disorders (e.g. Marfan syndrome, Ehlers–Danlos syndrome)

- Surgery following traumatic injury to the aorta"

Definite diagnosis of multiple sclerosis, which must be confirmed by a Consultant Neurologist and supported by all of the following criteria: 

- Current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months 

- Magnetic resonance imaging (MRI) showing at least two lesions of demyelination in the brain or spinal cord characteristic of multiple sclerosis

For the above definition, the following are not covered:

- Possible multiple sclerosis and neurologically or radiologically isolated syndromes suggestive but not diagnostic of multiple sclerosis

- Isolated optic neuritis and neuromyelitis optic"

- Personality change- Gradual onset and continuing decline of cognitive functions

- No disturbance of consciousness

- Typical neuropsychological and neuroimaging findings (e.g. CT scan)

The disease must require constant supervision (24 hours daily) [before age 65]. The diagnosis and the need for supervision must be confirmed by a Consultant Neurologist.

For the above definition, the following are not covered:- Other forms of dementia due to brain or systemic disorders or psychiatric conditions"     

acquired by intravenous drug use)"

- Complete unawareness of the self and the environment

- Inability to communicate with others

- No evidence of sustained or reproducible behavioral responses to external stimuli

- Preserved brain stem functions

- Exclusion of other treatable neurological or psychiatric disorders with appropriate neurophysiological or neuropsychological tests or imaging procedures

The diagnosis must be confirmed by a Consultant Neurologist and the condition must be medically documented for at least one month without any clinical improvement."

- Complete or incomplete surgical removal

- Stereotactic radiosurgery

- External beam radiation

If none of the treatment options is possible due to medical reasons, the tumor must cause a persistent neurological deficit¹ which has to be documented for at least 3 months following the date of diagnosis. The diagnosis must be confirmed by a Consultant Neurologist or Neurosurgeon and supported by imaging findings. 

For the above definition, the following are not covered:

- The diagnosis or treatment of any cyst, granuloma, hamartoma or malformation of the arteries or veins of the brain

- Tumors of the pituitary gland"

A definite diagnosis of severe liver disease evidenced by a Child-Pugh score of at least 7 points (Child-Pugh Class B or C). The score must be calculated by all of the following variables: 

- Total bilirubin levels

- Serum albumin levels 

- Severity of ascites

- International normalized ratio (INR)  

- Hepatic encephalopathy

The diagnosis must be confirmed by a Consultant Gastroenterologist and supported by imaging findings. 

For the above definition, the following are not covered:

- Severe liver disease secondary to alcohol or drug use (including hepatitis B or C infections acquired by intravenous drug use)"

A definite diagnosis of severe lung disease resulting in chronic respiratory failure and evidenced by all of the following:

- FEV1 (Forced Expiratory Volume at 1 second) being less than 40% of predicted on 2 measurements at least 1 month apart

- Treatment with oxygen therapy for at least 16 hours per day for a minimum of three months

- Persistent reduction in partial oxygen pressures (PaO2) below 55mmHg (7.3 kPa) in arterial blood gas analysis measured without administration of oxygen 

The diagnosis must be confirmed by a Specialist."

A definite diagnosis of a state of unconsciousness with no reaction or response to external stimuli or internal needs, which: 

- results in a score of 8 or less on the Glasgow coma scale for at least 96 hours, 

- requires the use of life support systems, and

- results in a persistent neurological deficit¹ which must be assessed at least 30 days after the onset of the coma.

The diagnosis must be confirmed by a Consultant Neurologist. 

For the above definition, the following are not covered:

- Medically induced coma

- Any coma due to self-inflicted injury, alcohol or drug use"

A definite diagnosis of a permanent and irreversible loss of hearing in both ears as a result of sickness or accidental injury. The diagnosis must be confirmed by a Consultant ENT specialist and supported by an average auditory threshold of more than 90 db at 500, 1000 and 2000 hertz in the better ear using a pure tone audiogram."

A definite diagnosis of acute viral encephalitis resulting in a persistent neurological deficit¹ documented for at least 3 months following the date of diagnosis. The diagnosis must be confirmed by a Consultant Neurologist and supported by typical clinical symptoms and cerebrospinal fluid or brain biopsy findings. 

For the above definition, the following are not covered:

- Encephalitis in the presence of HIV

- Encephalitis caused by bacterial or protozoal infections

- Myalgic or paraneoplastic encephalomyelitis"

A definite diagnosis of fulminant viral hepatitis evidenced by all of the following:

- Typical serological course of acute viral hepatitis 

- Development of hepatic encephalopathy 

- Decrease in liver size

- Increase in bilirubin levels

- Coagulopathy with an international normalized ratio (INR) greater than 1.5

- Development of liver failure within 7 days of onset of symptoms

- No known history of liver disease

The diagnosis must be confirmed by a Consultant Gastroenterologist.

For the above definition, the following are not covered:

- All other non-viral causes of acute liver failure (including paracetamol or aflatoxin intoxication)

- Fulminant viral hepatitis associated with intravenous drug use"

A definite diagnosis of a disturbance of the brain function as a result of traumatic head injury. The head trauma must result in a total inability to perform, by oneself, at least 3 out of 6 Activities of Daily Living for a continuous period of at least 3 months with no reasonable chance of recovery. 

Activities of Daily Living are: 

- Washing – the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means.

- Getting dressed and undressed – the ability to put on, take off, secure and unfasten all garments and, if needed, any braces, artificial limbs or other surgical appliances.

- Feeding oneself – the ability to feed oneself when food has been prepared and made available.

- Maintaining personal hygiene – the ability to maintain a satisfactory level of personal hygiene by using the toilet or otherwise managing bowel and bladder function.

- Getting between rooms – the ability to get from room to room on a level floor.

- Getting in and out of bed – the ability to get out of bed into an upright chair or wheelchair and back again.

The diagnosis must be confirmed by a Consultant Neurologist or Neurosurgeon and supported by typical imaging findings (CT scan or brain MRI).

For the above definition, the following are not covered:

- Any major head trauma due to self-inflicted injury, alcohol or drug use"

For the above definition, the following are not covered:

- Loss of Limbs due to self-harm.

A definite diagnosis of the total and irreversible loss of the ability to speak as the result of physical injury or disease. The condition has to be present for a continuous period of at least 6 months. The diagnosis must be confirmed by a Consultant ENT Specialist. 

For the above definition, the following are not covered:

- Loss of speech due to psychiatric disorders"

Burns that involve destruction of the skin through its full depth to the underlying tissue (third-degree burns) and covering at least 20% of the body surface as measured by ""The Rule of Nines"" or the ""Lund and Browder Chart"". The diagnosis must be confirmed by a Specialist. 

For the above definition, the following are not covered:

- Third-degree burns due to self-inflicted injury

- Any first- or second-degree burns"

A definite diagnosis of one of the following motor neurone diseases: 

- Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)

- Primary lateral sclerosis (PLS)

- Progressive muscular atrophy (PMA)

- Progressive bulbar palsy (PBP)

The disease must result in a total inability to perform, by oneself, at least 3 out of 6 Activities of Daily Living for a continuous period of at least 3 months with no reasonable chance of recovery. 

Activities of Daily Living are: 

- Washing – the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means.

- Getting dressed and undressed – the ability to put on, take off, secure and unfasten all garments and, if needed, any braces, artificial limbs or other surgical appliances.

- Feeding oneself – the ability to feed oneself when food has been prepared and made available.

- Maintaining personal hygiene – the ability to maintain a satisfactory level of personal hygiene by using the toilet or otherwise managing bowel and bladder function.

- Getting between rooms – the ability to get from room to room on a level floor.

- Getting in and out of bed – the ability to get out of bed into an upright chair or wheelchair and back again.

The diagnosis must be confirmed by a Consultant Neurologist and supported by nerve conduction studies (NCS) and electromyography (EMG). 

For the above definition, the following are not covered:

- Multifocal motor neuropathy (MMN) and inclusion body myositis

- Post-polio syndrome 

- Spinal muscular atrophy

- Polymyositis and dermatomyositis"

A definite diagnosis of one of the following muscular dystrophies: 

- Duchenne Muscular Dystrophy (DMD)

- Becker Muscular Dystrophy (BMD) 

- Emery-Dreifuss Muscular Dystrophy (EDMD)  

- Limb-Girdle Muscular Dystrophy (LGMD) 

- Facioscapulohumeral Muscular Dystrophy (FSHD)

- Myotonic Dystrophy Type 1 (MMD or Steinert's Disease) 

- Oculopharyngeal Muscular Dystrophy (OPMD)

The disease must result in a total inability to perform, by oneself, at least 3 out of 6 Activities of Daily Living for a continuous period of at least 3 months with no reasonable chance of recovery. 

Activities of Daily Living are: 

- Washing – the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means.

- Getting dressed and undressed – the ability to put on, take off, secure and unfasten all garments and, if needed, any braces, artificial limbs or other surgical appliances.

- Feeding oneself – the ability to feed oneself when food has been prepared and made available.

- Maintaining personal hygiene – the ability to maintain a satisfactory level of personal hygiene by using the toilet or otherwise managing bowel and bladder function.

- Getting between rooms – the ability to get from room to room on a level floor.

- Getting in and out of bed – the ability to get out of bed into an upright chair or wheelchair and back again.

The diagnosis must be confirmed by a Consultant Neurologist and supported by electromyography (EMG) and muscle biopsy findings. 

For the above definition, the following are not covered:

- Myotonic Dystrophy Type 2 (PROMM) and all forms of myotonia."

A definite diagnosis of primary idiopathic Parkinson's disease, which is evidenced by at least two out of the following clinical manifestations: - Muscle rigidity

- Tremor

- Bradykinesia (abnormal slowness of movement, sluggishness of physical and mental responses)

Idiopathic Parkinson's disease must result [before age 65] in a total inability to perform, by oneself, at least 3 out of 6 Activities of Daily Living for a continuous period of at least 3 months despite adequate drug treatment.  

Activities of Daily Living are: - Washing – the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means.

- Getting dressed and undressed – the ability to put on, take off, secure and unfasten all garments and, if needed, any braces, artificial limbs or other surgical appliances.

- Feeding oneself – the ability to feed oneself when food has been prepared and made available.

- Maintaining personal hygiene – the ability to maintain a satisfactory level of personal hygiene by using the toilet or otherwise managing bowel and bladder function.

- Getting between rooms – the ability to get from room to room on a level floor.

- Getting in and out of bed – the ability to get out of bed into an upright chair or wheelchair and back again.

The diagnosis must be confirmed by a Consultant Neurologist. 

The implantation of a neurostimulator to control symptoms by deep brain stimulation is, independent of the Activities of Daily Living, covered under this definition. The implantation must be determined to be medically necessary by a Consultant Neurologist or Neurosurgeon. 

For the above definition, the following are not covered:

- Secondary parkinsonism (including drug- or toxin-induced parkinsonism)

- Essential tremor

- Parkinsonism related to other neurodegenerative disorders"

A definite diagnosis of severe chronic pancreatitis evidenced by all of the following: 

- Exocrine pancreatic insufficiency with weight loss and steatorrhoea

- Endocrine pancreatic insufficiency with pancreatic diabetes

- Need for oral pancreatic enzyme substitution 

These conditions have to be present for at least 3 months. The diagnosis must be confirmed by a Consultant Gastroenterologist and supported by imaging and laboratory findings (e.g. faecal elastase).

For the above definition, the following are not covered:

- Chronic pancreatitis due to alcohol or drug use

- Acute pancreatitis"

- Typical symptoms of inflammation (arthralgia, swelling, tenderness) in at least 20 joints over a period of 6 weeks at the time of diagnosis and significantly increased CRP levels. 

- Rheumatoid factor positivity (at least twice the upper normal value) and/or presence of anti-citrulline antibodies

- Continuous treatment with corticosteroids 

- Treatment with a combination of “Disease Modifying Anti-Rheumatic Drugs” (e.g. methotrexate plus sulfasalazine/leflunomide) or a TNF inhibitor over a period of at least 6 months

The diagnosis must be confirmed by a Consultant Rheumatologist. 

For the above definition, the following are not covered:

- Reactive arthritis

- Psoriatic arthritis

- Activated osteoarthritis"

Critical Illness Definitions – Children Covers

Leukaemia, malignant lymphoma, myelodysplastic syndrome, polycythemia rubra vera, essential thrombocythaemia are covered under this definition.

For the above definition, the following are not covered:

Any tumour histologically classified as pre-malignant, non-invasive or carcinoma in situ (including CIN-1, CIN2 and CIN 3)

Papillary thyroid cancer less than 1 cm in diameter and histologically described as T1N0M0

Basal cell carcinoma and squamous cell carcinoma of the skin and malignant melanoma stage IA (T1aN0M0) unless there is evidence for metastases

Gastric MALT Lymphoma if the condition can be treated with Helicobacter- eradication 

Gastrointestinal stromal tumour (GIST) stage I and II according to the AJCC Cancer Staging Manual, Seventh Edition (2010)

Wilms tumour stage I and favourable histology (no anaplasia)

- Bone marrow (allogeneic hematopoietic stem cell transplantation preceded by total bone marrow ablation)

For the above definition, the following are not covered:

- Transplantation of other organs, body parts or tissues (including cornea and skin)

- Transplantation of other cells (including islet cells and stem cells other than hematopoietic) "

The undergoing as a recipient of an allograft or isograft transplant of one or more of the following: 

Liver (including split liver and living donor liver transplantation)

Lung (including living donor lobe transplantation or single-lung transplantation)

Small bowel

Pancreas 

Partial or full face, hand, arm and leg transplantation (composite tissue allograft transplantation) is covered under this definition, too. The condition leading to transplantation must be deemed untreatable by any other means, as confirmed by a Specialist. 

For the above definition, the following are not covered:

Transplantation of other organs, body parts or tissues (including cornea and skin)

Transplantation of other cells (including islet cells and stem cells other than hematopoietic)

Transplantation due to congenital malformations or abnormalities

The undergoing as a recipient of an allograft or isograft transplant kidney.

For the above definition, the following are not covered:

Transplantation of other organs, body parts or tissues (including cornea and skin)

Transplantation of other cells (including islet cells and stem cells other than hematopoietic)

Transplantation due to congenital malformations or abnormalities

The undergoing as a recipient of an allograft or isograft transplant of heart

For the above definition, the following are not covered:

Transplantation of other organs, body parts or tissues (including cornea and skin)

Transplantation of other cells (including islet cells and stem cells other than hematopoietic)

Transplantation due to congenital malformations or abnormalities

Total and irreversible loss of muscle function to the whole of any 2 limbs as a result of injury to, or disease of the spinal cord or brain. Limb is defined as the complete arm or the complete leg. Paralysis must be present for more than 3 months, confirmed by a Specialist and supported by clinical and diagnostic findings. 

For the above definition, the following are not covered:

Paralysis due to self-harm or psychological disorders

Paralysis due to congenital abnormalities of the brain and/or spinal cord including brain tumours and spinal cord tumours

Guillain-Barré-Syndrome

Periodic or hereditary paralysis

A definite diagnosis of a state of unconsciousness with no reaction or response to external stimuli or internal needs, which: 

results in a score of 8 or less on the Glasgow coma scale for at least 96 hours, 

requires the use of life support systems, and

results in a persistent neurological deficit which must be assessed at least 30 days after the onset of the coma.

The diagnosis must be confirmed by a Consultant Neurologist. 

For the above definition, the following are not covered:

Medically induced coma:

Any coma due to child abuse or assault by legal guardian or other familial violence

Any coma due to self-inflicted injury, alcohol or drug use

Any coma due to birth complications or congenital malformations

Burns that involve destruction of the skin through its full depth to the underlying tissue (third-degree burns) and covering at least 10% of the body surface as measured by the "Lund and Browder Chart". The diagnosis must be confirmed by a Specialist. 

For the above definition, the following are not covered:

Third-degree burns due to self-inflicted injury

Third-degree burns due to child abuse or assault by legal guardian or other familial violence

Any first- or second-degree burns

A definite diagnosis of a disturbance of the brain function as a result of traumatic head injury. The head trauma must result in a score of 3-5 on the Paediatric Glasgow coma scale (PGCS) and in permanent neurological deficits for at least 3 months following the date of diagnosis.

The diagnosis and neurological deficit, with no reasonable chance of recovery must be confirmed by a Specialist and supported by typical imaging findings (CT scan or brain MRI).

For the above definition the following is not covered:

Any major head trauma due to child abuse or assault by legal guardian or other familial violence

Any major head trauma due to self-inflicted injury, alcohol or drug use

Profound vision loss of both eyes resulting from either disease or trauma that cannot be corrected by refractive correction, medication, or surgery. Profound vision loss is evidenced by either a visual acuity of 3/60 or less (0.05 or less in the decimal notation) in the better eye after best correction or a visual field of less than 10° diameter in the better eye after best correction. The diagnosis must be confirmed by a Specialist. The diagnosis needs to be supported by appropriate testing. In children < 3 years of age, objective tests (e.g. visual evoked potential) are needed.

For the above definition, the following is not covered:

Any form of blindness or profound vision disturbance that is congenital or hereditary including blindness/profound vision disturbance due to infection during pregnancy.

A definite diagnosis of a permanent and irreversible loss of hearing in both ears as a result of sickness or accidental injury, which cannot be sufficiently compensated by hearing aids to allow normal communication (auditory threshold of more than 90dB). The diagnosis must be confirmed by a Consultant ENT specialist and supported by objective audiometry (e.g. Auditory brain stem response).

For the above definition, the following is not covered:

Any form of deafness that is congenital or hereditary including deafness due to infection during pregnancy.

A definite diagnosis of a benign brain tumour, which is defined as a non-malignant growth of tissue located in the cranial vault and limited to the brain, meninges or cranial nerves. The tumour must be treated with at least one of the following: 

Complete or incomplete surgical removal

Stereotactic radiosurgery

External beam radiation

If none of the treatment options is possible due to medical reasons, the tumour must cause a persistent neurological deficit, which has to be documented for at least 3 months following the date of diagnosis. The diagnosis must be confirmed by a Specialist and supported by imaging findings. 

For the above definition, the following are not covered:

The diagnosis or treatment of any cyst, granuloma, hamartoma or malformation of the arteries or veins of the brain

Tumours of the pituitary gland

Congenital tumours

A definite diagnosis of Systemic juvenile idiopathic arthritis leading to all of the following: 

Joint destruction requiring joint replacement

Typical extra-articular manifestations

The diagnosis and necessity for joint replacement must be confirmed by a Specialist. Furthermore, the joint replacement must have taken place.

For the above definition, the following is not covered:

Systemic juvenile idiopathic arthritis that can be adequately treated with medication

Systemic juvenile idiopathic arthritis not leading to joint replacement

Bacterial bone and joint infections 

Viral and postinfectious arthritis and Other autoimmune and autoinflammatory diseases

Definite diagnosis of multiple sclerosis, which must be confirmed by a Consultant Neurologist and supported by all of the following criteria: 

- Current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months 

- Magnetic resonance imaging (MRI) showing at least two lesions of demyelination in the brain or spinal cord characteristic of multiple sclerosis

For the above definition, the following are not covered:

- Possible multiple sclerosis and neurologically or radiologically isolated syndromes suggestive but not diagnostic of multiple sclerosis

- Isolated optic neuritis and neuromyelitis optic"

"Permanent and irreversible

A definite diagnosis of the total and irreversible loss of the ability to speak as the result of physical injury or disease. The condition has to be present for a continuous period of at least 6 months. The diagnosis must be confirmed by a Consultant ENT Specialist. 

For the above definition, the following are not covered:

- Loss of speech due to psychiatric disorders"

(Minimum age: 3 years)

 Persistent vegetative state

"A vegetative state is absence of responsiveness and awareness due to dysfunction of the cerebral hemispheres, with the brain stem, controlling respiration and cardiac functions, remaining intact. The definite diagnosis must be evidenced by all of the following: 

- Complete unawareness of the self and the environment

- Inability to communicate with others

- No evidence of sustained or reproducible behavioral responses to external stimuli

- Preserved brain stem functions

- Exclusion of other treatable neurological or psychiatric disorders with appropriate neurophysiological or neuropsychological tests or imaging procedures

The diagnosis must be confirmed by a Consultant Neurologist and the condition must be medically documented for at least one month without any clinical improvement."

A definite diagnosis of fulminant viral hepatitis evidenced by all of the following:

- Typical serological course of acute viral hepatitis 

- Development of hepatic encephalopathy 

- Decrease in liver size

- Increase in bilirubin levels

- Coagulopathy with an international normalized ratio (INR) greater than 1.5

- Development of liver failure within 7 days of onset of symptoms

- No known history of liver disease

The diagnosis must be confirmed by a Consultant Gastroenterologist.

For the above definition, the following are not covered:

- All other non-viral causes of acute liver failure (including paracetamol or aflatoxin intoxication)

- Fulminant viral hepatitis associated with intravenous drug use"

Clause 4- Responsibilities of Policyholder, Insured and users:

• Policyholder must pay the annual premium, unless agreed by the parties to do in other ways

• According to each case, policyholder or the insured, provide the insurer with request form of the policyholder, opinion of care provider doctor, or coroner (certified copy), original invoice of health care costs or other required documents and answers all questions related to the insurance records sincerely.

• The beneficiary of critical illness sum assured is the insured. If the insured is under 18 years old, the sum assured will be awarded to his/her legal guardian. 

The policyholder must inform the insurer at most 30 days after being infected by covers illnesses. 

Provision: In case the policyholder or insured refrain to do obligations mentioned in this clause, the insurer may refuse to pay for all or part of his/her commitments.

Clause 5- Coverage Period:

Period of this coverage is equal to one full solar year and it begins since the date of policy issuance, and each policy year it will be renewed automatically based on policy table, unless there is another agreement between the parties.

Provision: Maximum age of the adult insured for using this coverage must be 60 years and it must be 18 years for children.

Clause 6- Insurer’s commitment

Commitment of the insurer is equal to critical illness sum insured, and diseases mentioned in insurance policy for first year and mentioned in annual reports of next years. The benefit payout is lump sum. After a claim from one group occurred, 100% of the sum insured will be paid out, the respective group ceases from the cover and, the cover continues and the premium is not reduced. A maximum of 3 payouts is possible, after the third payout the full cover ceases

Clause 7- Exceptions

A. Becoming ill to diseases mentioned in Clause 2 and 3 as a result of addiction, drunkenness or consuming any drugs or stimulant substances without prescribtion of doctor.

B. Becoming ill to any type of disease other than the ones mentioned in Clause 2 and 3.

Clause 8- Understatement:

 In case it is revealed that the insured or his/her guardian or policyholder, before issuance of the policy were aware of previous disease or necessity of treatment for diseases mentioned in Clause 2 and 3 and they have not informed the insurer, the insurer has no obligation to compensate the resulted loss.

Clause 9- Waiting period:

Waiting period is a duration with no obligation for insurer to compensate losses. Waiting period for critical illnesses is 90 days.

Provision: Waiting period for multiple sclerosis is 180 days.

Clause 10: Survival period

The critical illness sum insured will be paid if the insured is survived 30 days after illness diagnosis and the insurer has no obligation to compensate the claim if the insured dies in waiting period. 

This rider and its ensuing effects are applicable and valid only if officially signed and confirmed by Saman Insurance.

Conditions of Accidental Death or Disability coverage

Clause 1- Insurance Topic: 

Based on this annex, by receiving the extra premium, the insurer guarantees to cover accidental death or disability risks.

Clause 2- Risks Coverage

1. Accidental Death: This results from any sudden event culminating in the insured’s death; that is caused by an external factor, totally unintended by the insured.
   
   
2. Permanent disability due to accident: The insured will be considered disabled based on clause 4 of this text.

Provision: Drowning, poisoning, gas, steam, or corrosive substances dangers, rabies, tetanus, anthrax, legitimate defence of the insured or trying to rescue people or their property from danger are all considered as accidents, and deaths, deformities, or permanent disabilities due to them are covered in the insurance policy.

Clause 3- Sum insured

Provision: The value of accidental death sum insured of each year is determined according to the value inscribed in the previous annual report before the insured’s death, and it will be paid to the beneficiaries.

Provision: Accidental disability sum insured in each year is determined according to a percent of death sum insured inscribed in the policy table.  Payments in each policy year are determined according to the disability sum insured mentioned in the last annual report, before the insured disability.

Clause 4- Insurer’s Commitments:

• Accidental Death: The insurer guarantees that in this coverage framework, in the case of insured’s death due to the accident, the sum insured specified for this coverage in the life insurance policy will be paid to the beneficiaries.

• Permanent disability due to accident: The insurer guarantees that the permanent disability indemnity due to accident is paid to beneficiaries, based on the conditions cited in the life insurance policy, its appendices and the following disability items.

A) Permanent and complete disability:

The following items are considered as permanent and complete disability; and their indemnities equal 100 percent of disability sum insured.

1. Complete blindness in both eyes.
2. Permanent and complete disability of both hands, at least from the wrists.
3. Permanent and complete disability of both legs, at least completely from the paws.
4. Permanent and complete disability of one hand and one leg, at least from the wrists.
5. Complete spinal cord lesion.
6. Permanent and complete deafness of both ears.
7. Mandible removal.

B) Permanent and partial disability:

The following items are considered as permanent and partial disability; their indemnities equal a percent of disability sum insured which are specified for each body parts according to what follows:

1. Loss of speech (dumbness) including larynx or loss of the tongue 80%
2. Permanent disability or amputated hand from the arm 70%
3. Permanent disability or amputated hand from the forearm 60%
4. Permanent disability or amputated hand from the wrist 55%
5. Permanent disability or amputated fingers of each hand 50%

5-1- Thumb 36%- first knuckle 24%

5-2- Index finger 25%- first knuckle 13%- first and second knuckle 20%

5-3- Middle and ring fingers 15%

5-4- Pinky 10%

Provision: In any case, the maximum commitment of the insurer for the finger disability of each hand will not exceed 50% of the total sum insured, and if all the fingers of both hands get amputated and then completely disabled, the maximum payable amount will equal 80% of the sum insured.

1. Permanent disability or amputated leg from the hip 70%
2. Permanent disability or amputated leg from the shin 60%
3. Permanent disability or amputated leg from the ankle 55%
4. Permanent disability or amputated foot fingers 30%

1-9- toe 10%

2-9- every other finger 5%

Provision: If the insured had been completely blind in one eye before the accident, the disability degree of the other eye’s blindness will be 80%.  

Provision: If the insured had been already deaf in one ear before the accident, the degree for losing the other ear’s hearing will be 65%.

1. Teeth loss 28% maximum
2. Loss of smell (anosmia) 15%
3. Loss of sense of taste 15%
4. One kidney 30%
5. Spleen 7%
6. Testicles 5%
7. The indemnity for disability of other parts of head (skull) and face will not exceed 40% of the sum insured.

C) Other permanent disability items:  Apart from those items mentioned earlier for permanent disability in provisions A and B, the disability (whether complete or partial) of any other cases and also their indemnity will be determined by the insurer’s private physician. 

Provision 1:  If the policyholder objects to the decree of insurer’s physician, the topic will be decided upon in a committee including the insurer’s physician, the policyholder’s physician, and a third physician selected by the first two. The opinion of the majority is binding for both sides.

Provision 2:  In all items of this topic, the recognition of disability and permanent disability, whether complete or partial and its degree will be determined by the insurer’s private physician.

Clause 5- The commitments of the policyholder, the insured, and the beneficiaries:

• The policyholder is required to pay the annual premium in cash, unless otherwise agreed by both sides.
  
  
• Depending on each case, the policyholder or the beneficiary must deliver the insured’s death or disability documents, or other required documents, to the insurer and also answer any question regarding the accident, honestly.

• The insured’s job switching must be informed to the insurer by the policyholder; otherwise less indemnity will be paid in proportion to the insured’s risk augmentation.

Provision: If the policyholder or the insured disregard the items mentioned in this clause, the insurer has the permission to ignore all or part of his/her commitments.

Clause 6- Exceptions:

a) Any kind of intervertebral disc or arthritis.

b) Intentional Body damages caused by the insured.

c) The insured’s mental illness or insanity, unless the illness or insanity is caused by an accident included in this annex.

d) The insured’s death due to an event that was planned by the beneficiary (including management, participation, or assistance).  In this case, the insurer is only required to pay the shares of other beneficiaries.

2)  The covered risks are excluded from the insurer’s commitment in the following cases: 

a) Drunkenness or any use of drug and stimulants without doctor’s permission.

b) Committing crimes, including management, participation or any assistance.

c) Death or disability of the insured when driving a vehicle without having its certificate.

d) War, riot, uprising, strike, chaos, coup d’état, and military and disciplinary officials’ precautionary actions.

e) Nuclear interactions.

f) Riding or sitting in a training, exploratory, or non-commercial aircraft. Riding or sitting in a racing car or a helicopter, diving, parachuting, free fall and steering a kite, or other similar motor-less vehicles.

Clause 7- Other risks:

The following risks are not included in the insurer’s commitment, unless by paying extra premium and the insurer’s agreement.

a) Earthquake and volcano.

b) Martial arts, hunting, riding (horse and etc.), boating, steering gear motorcycles up to 150 cc volume.

Clause 8- Coverage period:

The coverage period is a complete solar year, beginning from the 00:00’ o’clock of the day specified in the policy to that exact time next year, unless otherwise are agreed upon between the two sides.

Provision: the maximum age of the insured for using the accidental death coverage is 70, and for using accidental permanent disability is 60 years of age.

This rider and its ensuing effects are applicable and valid only if officially signed and confirmed by Saman Insurance. 

Conditions of Waiver of Premium (WOP) or income due to the complete disability 

Clause 1. Insurer’s commitment 

Based on this annex, the insurer guarantees that in place of receiving an extra premium, he will exempt the policyholder of paying any premium in the case of insured’s complete disability caused by accident or illness. The annual value of WOP is equal to the policy’s premium at the year on which the disability happens, and exemption will terminate in each of the following cases:

a. Policy’s termination

b. After receiving WOP for a period of 10 years

c. Termination of the insured's disability

d. Insured's age gets above 65

Provision 1: in WOP, exemption amount can be any coefficient of the annual premium, with the agreement of insurer.

Provision 2: if disability income is checked in the policy, the insurer guarantees that in the case of receiving WOP and disability income premium, he pays the assigned coefficient (up to 3 times of the exemption amount) as income to the policyholder. Meanwhile, conditions of receiving a disability income are according to the WOP coverage.

Clause 2: Complete Disability

Disability can occur due to accident or illness. The insured is considered “completely disabled” when the forensics or other jurisdictions confirm his/her status. In this case, it will be covered by this rider. In other cases, the recognition of temporary/permanent disability, its completeness or partialness, and also determining the disability period are all decided by the insurer’s private physician or official loss adjuster. Complete disability occurs due to each of the following items. 

1. Complete blindness in both eyes.
2. Complete disability of both hands, from wrist at least.
3. Permanent disability of both legs, at least totally from the paws.
4. Permanent disability of one hand and one leg, at least totally from the wrist.
5. Loss of both claws.
6. Complete spinal cord lesion.
7. Complete ear deafness.
8. Mandible removal.

Provision: Complete disability is divided as follow: 

1. Permanente and complete disability 
   
   
2. Temporary and complete disability: In this case the duration of temporary disability is at least one year and renewing that depends on providing doctor’s certificate. Partial disability dose is not covered.  

Provision: in all items of this clause, the recognition of temporary/permanent disability, its completeness or partialness, and also determining the disability period are all decided by the insurer’s private physician. If the insured objects to the decree of insurer’s physician, the topic will be decided upon in a committee including the insurer’s physician, the insured’s physician, and a third physician selected by the first two. The opinion of the majority is binding for both sides.

Partial disability is not covered in this topic.

Clause 3. Risk Coverage

a. Accident: a sudden event caused by an external factor that is not intended or planned by the insured, resulting in complete disability. The following items are considered as accident:

• Kitchen gas, steam or corrosive substances like acid.
• Infected by Harry, Tetanus, anthrax and bites
• Legitimate defense of the insured from himself/herself
• Trying to rescue people or their properties
• illness:  every kind of disease or malady confirmed by the insurer’s private physician that causes complete disability.

Clause 4- Special Conditions

In the case that the policyholder and the insured are not identical, the coverage of WOP is awarded to the policyholder.

Clause 5- The policyholder’s duties in case of accident:

Right after any accident, except death, the insured is required to consult a physician, and also regard his/her recommendations and treatments.  It is necessary for the policyholder to give written notice to the insurer, at most in one month after the accident; otherwise, the insurer may refuse the claim payment. 

Clause 6- Waiting Period

The insurer’s commitment will start after 90 days waiting period, after the policy issuance.

 Clause 7- Exceptions

In addition to the general condition exceptions which lead to complete disability of policyholder, the following items or their consequential risks are not included in the insurer’s commitments:

a. suicide or suicide attempt.

b. intended damages to the body, by the policyholder. 

c. drunkenness or any use of drug and stimulants.

d. Use of sedatives and hypnotics without doctor’s permission.

e. committing crimes, including management, participation or any assistance.

f. any kind of intervertebral disc or arthritis.

g. the insured’s mental illness or insanity, unless the illness or insanity is caused by the kind of accident included in the policy.

h. War (except for the explosion or operation of military equipment left after the war)

Uprising, revolution, riot, strike, uprising, riot, coup and precautionary measures by military officials.

I. earthquake, volcano, nuclear activities. 

Clause 8- Coverage Period:

The coverage period is a complete solar year, beginning from the policy issue date and it will be renewed automatically each year, unless otherwise is agreed upon between the two sides.

Clause 9- The Maximum Age of the Insured

This coverage extends until the policyholder’s 65 years old.  In case of the policyholder’s complete disability after 55, WOP and income extends maximum to the insured’s 65.

Clause 10: Understatement

In case it is revealed that the policyholder, before issuance of the policy was aware of preexistence of medical condition, they have not informed the insurer, the insurer has no commitment to compensate the resulted loss.

Clause 11- Legal claims

Paragraph 1- amendment: every debatable topic in this policy will be refereed and reconciled. In this case, each side choses a referee, then the referees specify a head-referee. The vote of the majority is binding for both sides. The related expenses for each referee will be paid by the pertaining side and the head-referee expenses will be divided between the sides.

Paragraph 2- unspecified or vague items: all of the unspecified or vague items in this policy under the insurance rule are the approved regulations of the insurance council and other jurisdictions of Iran.

This rider and its ensuing effects are applicable and valid only if officially signed and confirmed by Saman Insurance.